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[Analysis of outpatients readmitted to an ambulatory surgery program]. / Análisis de los reingresos hospitalarios domiciliarios en un programa de cirugía mayor ambulatoria.

OBJECTIVES: To quantify readmission rates due to both major and minor complications per year of study in an ambulatory surgery program and to assess the effect of including patients with greater severity on the results. PATIENTS AND METHOD: We performed a retrospective study of patients undergoing surgery in an ambulatory surgery program in our health center between 1998 and 2003. During the study period, 25,553 patients met the selection criteria for elective ambulatory surgery. To analyze the evolution of complications over the study period, the first year of the study period was taken as the reference, and the chi(2) test was used to measure tendency, obtaining annual odd ratios (OR) and their respective confidence intervals. RESULTS: The substitution index in the study period was 55.25%. The proportional risk of a major complication in our series was 1:426. The number of patients readmitted from home represented 0.83% of the total number of patients undergoing ambulatory surgery. The most common causes of readmission were surgically-related occurrences, mainly bleeding from the surgical site. Most complications were minor, the most frequently found problem being pain in the surgical wound. CONCLUSIONS: Safety is an attitude and when the surgeon and the anesthesiologist apply appropriate patient selection criteria and perform a careful preanesthesia evaluation, there is no reason to expect more complications in ambulatory patients than in inpatients.

Análisis de los reingresos hospitalarios domiciliarios en un programa de cirugía mayor ambulatoria / Analysis of outpatients readmitted to an ambulatory surgery program

Objetivos. Cuantificar las tasas de reingresos por complicaciones mayores y menores por años de estudio de un programa de cirugía mayor ambulatoria (CMA) y evaluar la inclusión de pacientes con un estado basal más deteriorado en los resultados. Pacientes y método. Estudio retrospectivo de los pacientes intervenidos en un programa de CMA en nuestro centro durante el período de 1998-2003. En el período de estudio citado se intervino de forma programada y con criterios de selección de CMA a un total de 25.553 pacientes. Para analizar la evolución de las complicaciones en el período de estudio, utilizamos la prueba de la χ² de tendencias, en la que se obtuvieron odds ratio anuales y sus intervalos de confianza teniendo como referencia el primer año del estudio. Resultados. El índice de sustitución en el período de estudio fue del 55,25%. El riesgo proporcional de tener una complicación mayor en nuestra serie es de 1:426. El total de pacientes con reingreso hospitalario procedente de su domicilio representa 0,83% del total de pacientes intervenidos en régimen de CMA. La causa más común de reingreso hospitalario en el presente trabajo son los factores quirúrgicos, principalmente la hemorragia del lecho quirúrgico. La mayoría de las complicaciones son menores o leves, y el dolor en la zona de la herida quirúrgica es el problema encontrado con más frecuencia. Conclusiones. La seguridad es una actitud y cuando se siguen buenos principios de selección del paciente por el cirujano y anestesiólogo, con evaluación preanestésica cuidadosa, no hay motivo para esperar más complicaciones que en pacientes hospitalizados (AU)

Objectives. To quantify readmission rates due to both major and minor complications per year of study in an ambulatory surgery program and to assess the effect of including patients with greater severity on the results. Patients and method. We performed a retrospective study of patients undergoing surgery in an ambulatory surgery program in our health center between 1998 and 2003. During the study period, 25,553 patients met the selection criteria for elective ambulatory surgery. To analyze the evolution of complications over the study period, the first year of the study period was taken as the reference, and the χ² test was used to measure tendency, obtaining annual odd ratios (OR) and their respective confidence intervals. Results. The substitution index in the study period was 55.25%. The proportional risk of a major complication in our series was 1:426. The number of patients readmitted from home represented 0.83% of the total number of patients undergoing ambulatory surgery. The most common causes of readmission were surgically-related occurrences, mainly bleeding from the surgical site. Most complications were minor, the most frequently found problem being pain in the surgical wound. Conclusions. Safety is an attitude and when the surgeon and the anesthesiologist apply appropriate patient selection criteria and perform a careful preanesthesia evaluation, there is no reason to expect more complications in ambulatory patients than in inpatients (AU)

Full breastfeeding and hospitalization as a result of infections in the first year of life.

OBJECTIVE: Our objective was to assess the effect of breastfeeding on the probability of hospitalization as a result of infectious processes during the first year of life METHODS: We followed 1385 infants from birth to age 1 year between 1996 and 1999. Recruitment and data collection were done at the 6-month well-infant visit under the National Child Health Program. Full breastfeeding, hospital admission, and other relevant variables related to the delivery, infant, mother, health services system, and sociologic aspects were recorded. The statistical analysis included Kaplan-Meier test, Cox regression to obtain the hazard ratio, and the adjusted attributable risk. RESULTS: Full breastfeeding at discharge after delivery and at 3, 4, and 6 months of age were 85%, 52%, 41%, and 15%, respectively; 78 hospital admissions as a result of infections were recorded (38 respiratory tract, 16 gastrointestinal tract). Mean age at admission was 4.1 months. After estimating the attributable risk, it was found that 30% of hospital admissions would have been avoided for each additional month of full breastfeeding. Seemingly, 100% of full breastfeeding among 4-month-old infants would avoid 56% of hospital admissions in infants who are younger than 1 year. CONCLUSIONS: On the basis of the present data, we conclude that full breastfeeding would lower the risk for hospital admission as a result of infections among infants who are younger than 1 year within an industrialized country.

Monitorización de la Infección de Localización Quirúrgica al alta tras la introducción de un Programa de Cirugía Ambulatoria en la Colecistectomía / Monitoring of surgery infection associated with a program of ambulatory surgery in collecistectomy

Objetivo. Valorar la frecuencia de infecciones de localización quirúrgica al alta del paciente, trasla introducción de un programa de Cirugía Mayor Ambulatoria.Diseño. Estudio observacional de tipo transversal.Emplazamiento. Hospital de tercer nivel.Participantes. Pacientes colecistectomizados durante el año 2000 incluidos en el programa de Cirugía Mayor Ambulatoria.Mediciones Principales. Los pacientes colecistec-tomizados fueron revisados siete días despuésde la intervención por un cirujano y entrevistados telefónicamente un mes más tarde por una enfermera de Medicina Preventiva. Calculamos el número de infecciones de localización quirúrgica detectadas por este método y la tasa de incidencia acumulada de infecciones global.Resultados. Fueron realizadas 157 entrevistas telefónicas. Se usó Profi láxis Antibiótica en 147pacientes (93,6%). Cinco pacientes presentaron infecciones de localización quirúrgica (3%).Dos de ellos (40%) se detectaron por cuestionario. La incidencia acumulada total de infecciones de localización quirúrgica fue de 3,18 x 100 pacientes operados (tasa de infecciones al alta 1,27 x 100 pacientes intervenidos y tasa de infecciones hospitalarias: 1,9 x 100 pacientes intervenidos).Conclusiones. La entrevista telefónica al alta aumenta la exhaustividad en la detección de casos de infecciones de localización quirúrgica. El bajo número de pacientes contactados y el mucho tiempo empleado en ello nos hace desechar, en nuestro caso, este método como un componente más del proceso de vigilancia

Objective. To know the frequency of surgical infection in the discharged patient, following the introduction of a programme of Major Ambulatory Surgery.Design. Observational and cross-sectional studyPlacement. Third level hospitalSubjects. Patients with collecistectomy in the year 2000, participating in a programme of MajorAmbulatory Surgery.Principal Measurements. Patients with collecistectomy were checked seven days after surgery, by a surgeon and interviewed by telephone one month later by a preventative medicine nurse. We calculated the number of surgical infections detected by this method and the rate of accumulated incidence of infections.Results. There were 157 interviews by telephone. Antibiotic prophylaxis was used in 147 patients(93.6%). Five patients suffered surgical infection (3%). Two of them (40%) were detected by questionnaire. The accumulated incidence of surgical infection was 3.18 / 100 of operated patients (the rate of infection in discharged patients = 1.27 / 100 of patients and the rate of infection in hospitalised patients = 1.9 / 100 of patients).Conclusions. The telephone interview after discharge, increases the detection rate of surgicalinfection. Due to the low number of patient contact and the amount of time invested in the work, we recommend in our case, the rejection of this method for the process of vigilance

Nosocomial infection surveillance in a surgical intensive care unit in Spain, 1996-2000: a time-trend analysis.

OBJECTIVE: To establish the occurrence, distribution, and secular time trend of nosocomial infections (NIs) in a surgical intensive care unit (ICU). DESIGN AND SETTING: Follow-up study in a teaching hospital in Spain. METHODS: In May 1995 we established an nosocomial infection surveillance system in our surgical ICU. We collected information daily for all patients who were in the ICU for at least 48 hours (546 patients from 1996 through 2000). We used the Centers for Disease Control and Prevention definitions and criteria for infections. Monthly, we determined the site-specific incidence densities of NIs, the rates of medical device use, and the Poisson probability distribution, which determined whether the case count equalled the number of expected cases (the mean number of cases during the previous year, with extreme values excluded). We compared yearly and monthly infection rates by Poisson regression, using site-specific NIs as a dependent variable and year and month as dummy variables. We tested annual trends with an alternative Poisson regression model fitting a single linear trend. RESULTS: The average rate of catheter-associated urinary tract infections was 8.4 per 1000 catheter-days; that of ventilator-associated pneumonia, 21 per 1000 ventilator-days; and that of central line-associated bloodstream infections, 30 per 1000 central line-days. The rate of urinary tract infections did not change over the study period, but there was a trend toward decreases in the rates of central line-associated bloodstream infections and ventilator-associated pneumonia. CONCLUSION: An NI surveillance and control program contributed to a progressive decrease in NI rates.

[Incidence of infectious spondylitis in the province of Albacete (Spain)]. / Incidencia de la espondilitis infecciosa en la provincia de Albacete.

BACKGROUND: Infectious spondylitis (IS) is an infrequent disease, although there are few data on its real incidence. To date, only one study, carried out in Denmark, that rigorously assesses the incidence of this disease has been published. OBJECTIVES: To determine the incidence of IS in the nonpediatric population of the province of Albacete, and to analyze differences according to etiology, age, sex, and geographical area. METHODS: We carried out a retrospective search of all the IS cases diagnosed in the province of Albacete during the period 1990-2002 and calculated the adjusted incidence rates using census data. RESULTS: The incidence of IS was 2.40 cases/10(5) inhabitants/year. Brucellar spondylitis had an incidence of 1.18 cases/10(5) inhabitants/year, with a predominance in the rural area and in men. Distribution by age was bimodal, with a first peak around 40 years old and a second peak around 60 years old. The incidence has significantly decreased in the last few years. Pyogenic spondylitis (incidence of 0.64 cases/10(5) inhabitants/year) showed a maximum incidence at around 60 years old, while its distribution by sex and geographical area was more uniform. Tuberculous spondylitis had an incidence of 0.45 cases/10(5) inhabitants/year and its frequency increased with age. CONCLUSION: The incidence rates of IS were higher than those reported in most previous studies, although they were similar to those observed in the most rigorous reports. These findings suggest that the frequency of IS could have been underestimated. The three etiologic groups analyzed showed distinct epidemiological profiles.

Incidencia de la espondilitis infecciosa en la provincia de Albacete / Incidence of infectious spondylitis in the province of Albacete (Spain)

Antecedentes. La espondilitis infecciosa es una enfermedad infrecuente, aunque existen pocos datos sobre su incidencia real. Hasta la fecha, sólo se ha publicado un estudio, realizado en Dinamarca, que valora de forma rigurosa su incidencia. Objetivos. Conocer la incidencia de espondilitis infecciosa en la población no pediátrica de la provincia de Albacete, así como el comportamiento por etiologías, grupos de edad y sexo y zonas geográficas. Métodos. Búsqueda retrospectiva de todos los casos diagnosticados de espondilitis infecciosa en la provincia de Albacete durante el período 1990-2002, calculando las tasas de incidencia ajustadas, a partir de los datos censales. Resultados. La incidencia de espondilitis infecciosa fue de 2,40 casos/10 5 habitantes/año. La incidencia de la espondilitis infecciosa brucelar fue 1,18 casos/10 5 habitantes/año, con predominio en la zona rural y en varones y con una distribución por edad bimodal (con un primer pico de incidencia alrededor de los 40 años y un segundo a los 60 años). Su incidencia se ha reducido de forma importante en los últimos años. La espondilitis infecciosa piógena (incidencia de 0,64 casos/10 5 habitantes/año) mostró un pico de incidencia alrededor de los 60 años y un comportamiento por sexo y por zonas geográficas mucho más uniforme. La espondilitis infecciosa tuberculosa tuvo una incidencia de 0,45 casos/10 5 habitantes/año y su frecuencia aumentó con la edad. Conclusión. Se obtuvieron tasas de incidencia superiores a la mayoría de los estudios previos y sólo comparables a los estudios más rigurosos, lo que sugiere que la incidencia de espondilitis infecciosa puede haber sido subestimada. Los tres grupos etiológicos del estudio mostraron un comportamiento epidemiológico distinto (AU)

Background. Infectious spondylitis (IS) is an infrequent disease, although there are few data on its real incidence. To date, only one study, carried out in Denmark, that rigorously assesses the incidence of this disease has been published. Objectives. To determine the incidence of IS in the nonpediatric population of the province of Albacete, and to analyze differences according to etiology, age, sex, and geographical area. Methods. We carried out a retrospective search of all the IS cases diagnosed in the province of Albacete during the period 1990-2002 and calculated the adjusted incidence rates using census data.Results. The incidence of IS was 2.40 cases/10 5 inhabitants/year. Brucellar spondylitis had an incidence of 1.18 cases/10 5 inhabitants/year, with a predominance in the rural area and in men. Distribution by age was bimodal, with a first peak around 40 years old and a second peak around 60 years old. The incidence has significantly decreased in the last few years. Pyogenic spondylitis (incidence of 0.64 cases/10 5 inhabitants/year) showed a maximum incidence at around 60 years old, while its distribution by sex and geographical area was more uniform. Tuberculous spondylitis had an incidence of 0.45 cases/10 5 inhabitants/year and its frequency increased with age. Conclusion. The incidence rates of IS were higher than those reported in most previous studies, although they were similar to those observed in the most rigorous reports. These findings suggest that the frequency of IS could have been underestimated. The three etiologic groups analyzed showed distinct epidemiological profiles (AU)

Relationship between the Arg72Pro polymorphism of p53 and outcome for patients with traumatic brain injury.

OBJECTIVE: To determine the relationship between the Arg72Pro polymorphism of p53 and the outcome after traumatic brain injury (TBI) in humans. DESIGN AND SETTING: A prospective study was carried out in a ten-bed surgical intensive care unit (SICU) of a university hospital. PATIENTS: The study included 90 caucasian patients who had experienced a severe TBI within the previous 24 h. The exclusion criterion was a previous deficit in the central nervous system. MEASUREMENTS AND RESULTS: The main recorded outcomes were values on the Glasgow Outcome Scale (GOS) at discharge from the SICU (GOS-0) and 6 months later (GOS-6). A blood sample was taken from each patient and all samples were analyzed by an allele-specific polymerase chain reaction for detection of Arg72Pro polymorphism of p53. These polymorphisms were tested for their association with values of GOS-0 and GOS-6. A two-tailed value of p<0.05 was considered statistically significant. The frequency of the argine/argine (Arg/Arg) genotype was greater among the patients who had a bad outcome at GOS-0 (69 vs 31% in the bad-outcome group; p=0.029). A multiple logistic regression analysis showed that patients with the Arg/Arg variation had a 2.9-fold greater risk of having a bad outcome at discharge from the SICU (95% confidence interval, 1.05-8.31; p=0.039 ). There was no similar relationship with respect to GOS-6. CONCLUSION: The Arg/Arg genotype of the Arg72Pro polymorphism in p53 is associated with increased likelihood of a bad outcome at discharge from the SICU.

Evaluación de un programa de reducción de las listas de espera quirúrgicas basado en la derivación de pacientes / Evaluation of a program to reduce surgical waiting-lists according to change in the surgical center

Objetivos: Identificar las variables relacionadas con la aceptación a ser derivado a otro hospital dentro de un programa de reducción de la lista de espera quirúrgica en el Hospital General (HG).Métodos: El estudio se llevó a cabo durante el primer semestre del año 1997 en la provincia de Albacete, que cuenta con dos hospitales públicos, el Complejo Hospitalario de Albacete (CHA) y el Hospital Comarcal (HC) de Hellín situado a 60 Km de Albacete capital. En el programa se planteaba la derivación voluntaria al HC de Hellín de todos los pacientes con más de tres meses de espera para ser intervenidos de herniorrafia, colecistectomía, tiroidectomía y cataratas, ofertándoles ser intervenidos en los diez días siguientes. En este estudio descriptivo se analiza: la frecuencia de aceptación según sexo, distancia en Kms. desde lugar de residencia, residencia en Albacete, tiempo de permanencia en la lista de espera, y el procedimiento quirúrgico, del total de los pacientes incluidos en el programa. Se utiliza el test de la 2 y el de la T-Student en el análisis univariante y el análisis de regresión logística múltiple (ARL) en el multivariante, considerando la aceptación o no como variable dependiente, y transformando la variable procedimiento quirúrgico en una dummy variable. Con los coeficientes ajustados de las variables seleccionadas calculamos el Riesgo Relativo y su intervalo de confianza al 95 por ciento. Resultados: Trescientos treinta y siete usuarios son contactados, 152 (45 por ciento) aceptan ser intervenidos en el HC. Se aprecian diferencias estadísticamente significativas en la frecuencia de aceptación al cambio según la distancia en Kms., la residencia en Albacete y el procedimiento quirúrgico. Cuando ajustamos estas variables con el ARL, sólo el ser residente en Albacete y el ser intervenido de cataratas presentan desviaciones estándar estadísticamente significativas. Conclusiones: El programa consigue reducir la lista de espera en un 45 por ciento. Los residentes en Albacete son los más reticentes a ser derivados al otro hospital variando el grado de aceptación en función del procedimiento quirúrgico de que se trate. Otras estrategias, como que el médico del paciente sea el que plantee la derivación, habrían de ser valoradas si se quiere aumentar la adhesión al programa (AU)